Oral Pain Management

Effective Treatment of Oral Pain

A recommendation by the U.S. Preventive Services Task Force, ‘National Panel Urges Changes to Addiction Screening,   is causing quite a stir and mixed reactions from the public. Medical and Dental practitioners are enjoined to conduct screening for illicit drug use among its patients. There is a lot of room for debate here.

Pain management is required for a number of dental procedures. It is administered to alleviate pain for a period of seven days immediately following a dental procedure. When prescribed together with non-opioid, non- steroidal anti-inflammatory drugs (NSAIDs), acetaminophen can be as effective.

Some statistics from IQVIA LRx (85 % of all outpatient prescriptions, including those written for patients covered by commercial insurers, Medicare and Medicaid):

  • In 2016, U.S. dentists wrote more than 11.4 million opioid prescriptions
  • U.S. dentists wrote 35.4 opioid prescriptions per 1,000 Americans

 

RELATED RESOURCE:

Download the Guide from the National Maternal and Child Oral Health Resource Center

Helpful Tips for Dentists from the NIH|NIDCR:

  • Consider non-steroidal anti-inflammatory analgesics (NSAIDs) as the first-line therapy for acute pain management.
  • Consider using multimodal opioid-sparing strategies such as pre-treatment with NSAIDS and long-acting local anesthesia.
  • If you consider prescribing an opioid for acute pain, follow the CDC guidelines:
    • Prescribe the lowest effective dose of immediate-release opioids.
    • Prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.
    • Note that three days or less will often be sufficient, and more than seven days will rarely be needed.
  • Be aware:  You may be the first to prescribe an opioid to an adolescent if you write a prescription after third molar extraction.  It’s also important to know research has shown that medical use of prescription opioids is highly correlated with non-medical use of prescription opioids among high school seniors.  Among adolescents who reported both types of use, medical use generally came first.4 In view of this risk, consider non-opioid analgesics for this population instead. 
  • Register with and use your state’s Prescription Drug Monitoring Program (PDMP) to promote the appropriate use of opioids and deter misuse and abuse.  When opioid prescribing is indicated, risk of misuse and diversion may be mitigated by consistent PDMP use and patient education.5
  • Counsel your patients if you prescribe an opioid pain medication:
    • Ask about any other medications they’re currently taking, and whether they or any family members have had problems with substance abuse, such as with alcohol, prescription medications, or illicit drugs.
    • Explain the risks of taking the medication.
    • Describe how to take the medicine and how long to take it.
    • Explain that alcohol should never be used when taking an opioid medication.
    • Provide guidance on storing medication in a safe place out of sight and out of reach of children, preferably in a locked cabinet.
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